No single diabetes diet fits all
Paula Deen, the queen of Southern cuisine, created a hoopla last month when she revealed that she has type 2 diabetes and has known about it for three years.
Some people were troubled that even after she was diagnosed, she continued to cook high-fat, high-sugar, high-calorie recipes on her TV show -- foods that people with the disease are advised to consume infrequently. Deen said she eats such foods only in moderation.
So what's the best diet for people with diabetes? There is no one diet, whether it's a Mediterranean, low-carb or low-fat diet, that is consistently better at helping people manage diabetes, says Stephanie Dunbar, director of nutrition and medical affairs for the American Diabetes Association. She is one of the authors of a new review of the research on diabetes diets published in February's Diabetes Care.
"People need to do what works for them. There are people who do well on a lower-fat diet and others who do well on a lower-carb diet." One thing that helps in keeping blood sugar under control is losing weight, even as little as 5% to 10% of body weight, Dunbar says.
Don't expect perfection
People with diabetes need to be counseled by a capable registered dietitian who can tailor their meal plan to their taste, says Ann Albright, director of the diabetes division for the Centers for Disease Control and Prevention. "If you give someone a list that says they have to eat this or that, and those are not foods they like, then they won't be successful, and they'll end up eating in secrecy." They need to make healthy choices most of the time, but an occasional indulgence is OK, she says. "That's one of the big burdens that people carry. Many say, 'I can't be perfect, so why try at all?'"
Almost 26 million adults and children, about 8.3% of the U.S. population, have diabetes, the CDC says. There are two major forms of diabetes: type 1 and 2. Type 2 accounts for more than 90% of cases. Factors that increase the risk of type 2 include a family history, obesity, inactivity and age.
In people with diabetes, the body does not make enough of the hormone insulin, or it does not use it properly. Insulin helps glucose (sugar) get into cells, where it is used for energy. If there's an insulin problem, sugar builds up in the blood, damaging nerves and blood vessels.
Symptoms include thirst, hunger, fatigue, blurry vision, healing problems and frequent urination. Complications can include heart attacks, blindness, kidney failure, nerve damage and amputations.
Lots of healthy choices
The diabetes association gives general guidance on carbohydrates, advising people to try to get about 45 to 60 grams at a meal, Dunbar says. "Some people may need more or less. About 45 grams allows someone to follow the diabetes plate method; we call it create your plate. It calls for half the plate to be non-starchy veggies, a fourth plate whole grains and a fourth plate protein."
People with the disease can eat from a wide range of healthy choices, says Geralyn Spollett, president of health care and education for the diabetes association and associate director of the Yale Diabetes Center. "It's really a balancing game of trying to eat healthy foods but still enjoy many of the things that they love."
But the diet shouldn't include a lot of sweets, Spollett says. "We stress reduced intake from concentrated sweets because they cause a spike in glucose, and that makes it difficult to manage your diabetes. We usually say to avoid things like soda and ginger ale and only to occasionally drink juice, because even though it has vitamins, it tends to cause blood sugar to skyrocket."
People with diabetes can have a sweet occasionally if they do it properly, Spollett says. "If someone is using insulin, they can calculate how much insulin they would need to reduce the spike in blood sugar caused by a sweet food. They can keep their blood glucose fairly even."
If they have type 2 diabetes and are not on insulin, they don't have that flexibility and need to be more conscious of how many sweet foods they eat, she says.
Fruit contains natural sugar fructose, so it can raise blood glucose, but it is a good source of vitamins and minerals and people should include it in their diet, Spollett says. Some find that the berries do not raise their glucose levels as much and will eat them, she says.
Even if you are taking medications for diabetes, making healthy food choices is important, Albright says.
Some people with diabetes appear to have a greater reaction to the foods they eat, she says. They have much more difficulty managing their blood sugar (A1C), blood pressure and cholesterol than others, she says.
But if people with diabetes keep their A1C level at 7% or less (an average glucose of 150-170 mg/dl), it can help reduce the risk of complications, Spollett says. "Unless people are eating in a way that is diabetes-friendly, it's very difficult to control their blood sugars."
Still, diabetes is a progressive disease, no matter how perfectly you live, Spollett says. "What people want to hear is that there is a cure, and we hope someday there will be, but in the meantime, people with diabetes need to do the best they can to keep their glucose in a healthy range."